Functional evaluation of early tendon transfer for thumb opposition in median nerve palsy

Thora, Ankit; Arora, Sumit; Dabas, V. S.; Khan, Yasim; Sankaran, Ajeesh; Dhal, Anil

doi:10.1016/j.jcot.2020.05.036

Cited by 3 publications

(3 citation statements)

References 12 publications

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“…Although the force almost doubled compared to preoperative grip force of 14 ± 2.2 kg, there is still a discrepancy to the 34 ± 2 kg on the healthy side. A recent study from Thora et al [ 21 ] showed a mean postoperative grip force of 16 kg after tendon transfer opposition-reconstruction. Although limited patient numbers, this data indicates a superior grip strength after FFMT compared to tendon transfers.…”

Section: Discussionmentioning

confidence: 99%

“…In comparison, Al-Quattan [ 23 ] and Thora et al [ 21 ] described their functional results for tendon transfers as “good” and “excellent” according to the score of Sundararaj et al [ 24 ]. This classification uses the term “excellent” for an opposition of the thumb to the tip of the fourth or fifth digit [ 23 , 24 ] which is equivalent to a Kapandji score of 5 respectively 6 [ 12 ].…”

Section: Discussionmentioning

confidence: 99%

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Single incision thenar muscle reconstruction using the free functional pronator quadratus flap

et al. 2021

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Background Injuries to the thenar muscle mass or the thenar branch of the median nerve and resulting loss of thumb opposition lead to a massive impairment of hand function. For decades, reconstructive approaches were based on tendon transfers. To broaden the reconstructive repertoire, we present the free functional pronator quadratus flap as a viable alternative for functional reconstruction and provide a specification for its indication. We demonstrate our surgical technique to a single incision reconstruction using the free functional pronator quadratus flap. Based on a series of three patients, which were analyzed for hand function using Kapandji’s score and the angle of Bourrel, grip strength and nerve conduction velocity in a two year follow up, we present an indication algorithm. Results After successful reinnervation of all flaps, we found an improvement of Kapandji’s score from 4.3 ± 0.94 preoperatively, to 8.7 ± 0.47 after two years. Accordingly, the angle of Bourrel decreased from 75.75 ± 3.45 degrees to 36.96 ± 3.68 degree. Grip strength also improved from 14 ± 2.2 kg to 26.2 ± 1.2 kg. No impairment of wrist pronation was observed. Conclusion We found excellent functional recovery of thumb opposition and strength, showing similar or even superior results compared to results from tendon transfers. With the benefit of a single incision surgery and therefore minimal donor site morbidity, this free functional muscle transfer is a viable alternative to classic tendon transfers.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Single incision thenar muscle reconstruction using the free functional pronator quadratus flap

et al. 2021

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“…Peripheral nerve injuries of the upper limb and brachial plexus lead to paralysis of muscles controlling the hand. The research articles by Agarwal et al 7,8 have discussed the management of radial nerve palsy by various tendon transfers and Dhal et al 9 have presented their experience of tendon transfers in medial nerve palsy. Flexor tendon injuries of the hand are serious in nature.…”

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confidence: 99%

A big disparity between the demand and supply of hand surgeons in India

Gupta

Vaishya

2020

Journal of Clinical Orthopaedics and Trauma

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Opponensplasty for Nerve Palsy: A Systematic Review

Coulshed

Graham

et al. 2023

Hand (New York, N,Y.)

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Opposition is an essential function of the human thumb to enable fine pinch and grip strength. Loss of opposition can be caused by both congenital and acquired pathology resulting in significant disability. This systematic review aims to compare the different techniques available to restore opposition. A systematic review of opponensplasty techniques was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-analysis guidelines using PubMed, Embase, Medline, and Web of Science. Studies published in English before April 2021 and that reported on original outcomes of opponensplasty techniques used in the context of neurologic dysfunction were eligible for inclusion. A total of 641 articles were included, of which 42 texts were eligible for inclusion with a total cohort of 873 patients. The most commonly used transfers were palmaris longus (PL), extensor indicis proprius (EIP), and flexor digitorum superficialis (FDS). These transfers all demonstrated an improvement in range of motion, pinch strength, and Kapandji scores. Complication rates of 19% and 12% were reported with FDS and EIP transfers, respectively, predominantly related to donor site morbidity. A complication rate of 6% was observed with PL transfers, which was most commonly related to bowstringing. Heterogeneity of outcomes precluded a direct statistical comparison. There is significant heterogeneity in the literature reporting on opponensplasty techniques. There is limited capacity of direct comparison; however, FDS and EIP appear to demonstrate better functional outcomes, at the cost of higher complication rates. Each technique has specific complications and advantages and importance in patient counseling and discussion. Further prospective comparative studies are warranted.

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Functional evaluation of early tendon transfer for thumb opposition in median nerve palsy

Cited by 3 publications

References 12 publications

Single incision thenar muscle reconstruction using the free functional pronator quadratus flap

Single incision thenar muscle reconstruction using the free functional pronator quadratus flap

A big disparity between the demand and supply of hand surgeons in India

Opponensplasty for Nerve Palsy: A Systematic Review

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